How to Identify Heart Valve Leakage

Heart valves are responsible for pumping blood into the chambers of the heart. When a valve leaks, it is called regurgitation. This happens when blood flows backward into the originating chamber because the valve either doesn't close properly or fails to close at all. This condition can affect any heart valve. Leaky valves make it harder for the heart to pump blood, causing the heart to work harder to pump the same amount of blood. Treatments may include medication or surgery, depending on the cause of the valve leakage and the severity of the condition.

Call emergency services if you experience chest pain. Chest pain has symptoms similar to heart valve leakage. Additionally, valve leakage can lead to chest pain. If unsure whether you’re experiencing a heart attack, you should call emergency services to be safe. Symptoms of a heart attack include:

• Chest pain or tightness
• Pain radiating to the neck, jaw, arm, or back
• Nausea
• Abdominal pain, especially in the upper middle region (epigastric area)
• Heartburn or indigestion
• Shortness of breath
• Excessive sweating
• Fatigue
• Dizziness or lightheadedness

See a doctor if you suspect mitral valve regurgitation. Heart conditions are often linked to mitral valve disorders. In this case, when the left ventricle contracts, blood flows into the aorta and then back into the originating chamber (left atrium). This leads to an increased blood volume in the left atrium, increased pressure in the pulmonary veins, and pulmonary swelling. If the condition is mild, you might not notice any symptoms. However, if it worsens, you may experience the following:

• Increased heart rate when lying on your left side
• Shortness of breath
• Coughing
• Chest tightness
• Swelling in the feet and ankles
• Dizziness
• Chest pain
• Heart failure

Consult a doctor if you suspect aortic valve regurgitation. When the left ventricle expands, blood flows into the aorta. However, if the valve is faulty, blood flows back into the left ventricle, increasing its blood volume and affecting its ability to pump blood. The walls of the aorta may become swollen. Aortic valve regurgitation can be congenital or caused by high blood pressure, infections, or valve damage. Symptoms include:

• A rumbling sound in the heart when the left ventricle expands
• Fast heartbeat
• Heart failure

Discuss pulmonary regurgitation with your doctor. Blood flows through the pulmonary valve from the heart to the lungs. If the valve leaks, blood flows back into the heart instead of into the lungs. This rare condition can be caused by congenital heart disease, high blood pressure, rheumatic fever, or cardiovascular infections. Not everyone with this condition will have symptoms, but if present, they may include:

• A rumbling sound between heartbeats
• Enlargement of the right ventricle
• Chest pain
• Fatigue
• Dizziness
• Fainting
• Heart failure

Consult a doctor about tricuspid valve regurgitation. This occurs when blood flows back into the right atrium instead of into the lungs during contraction of the right ventricle. It may result from right ventricular enlargement, emphysema, pulmonary artery stenosis, tricuspid valve infections, valve weakness or damage, tumors, rheumatoid arthritis, or rheumatic fever. Weight-loss drugs containing phentermine, fenfluramine, or dexfenfluramine can increase the risk of tricuspid valve regurgitation. Symptoms may include:

• Weakness
• Fatigue
• Swelling in the legs and feet
• Bloating
• Reduced urination
• Visible neck veins

Request a heart check-up from a cardiologist. A cardiologist can gather a lot of information by listening to the sounds and timing of blood flow through the heart. A leaky valve causes an abnormal rumbling sound as blood flows through the heart. The cardiologist will assess:

• The sound of blood flowing through the heart. If there is a rumbling sound, the doctor will listen to the intensity of the sound and its timing in relation to the heartbeat. This helps the doctor determine the severity of the valve leak and its location in the heart.
• Your medical history, including any conditions that may increase your risk of heart valve disease, such as heart infections, heart damage, high blood pressure, or congenital heart disease.

Allow the doctor to conduct a heart exam. The doctor can identify the location of the faulty valve and assess the severity of the condition. This is crucial for determining the cause of the heart valve leak and developing a treatment plan. The cardiologist may perform the following procedures:

• Echo Cardiogram. This procedure uses sound waves to create images of the heart. The doctor can check if the heart is enlarged or if the valve structure is abnormal. The doctor will examine the heart chambers and their functionality. The procedure lasts about 45 minutes, during which gel is applied to the chest, and the ultrasound device is moved around. It is non-invasive, painless, and safe.
• Electrocardiogram (ECG). This test records the intensity and duration of the electrical impulses that generate the heartbeat. It is a non-invasive, painless procedure. The technician will place electrodes on the skin to detect and measure the heart's electrical signals. The ECG can detect arrhythmias.
• Chest X-ray. This procedure is painless. X-rays pass through the body without causing any sensation and create an image of the heart. The doctor can identify which heart chamber is enlarged. A lead apron is worn to protect reproductive organs during the X-ray.
• Cardiac catheterization. This is an invasive procedure where a small catheter is inserted into a vein or artery and guided into the heart. The catheter measures the pressure in the different chambers of the heart, providing valuable information for diagnosing heart valve issues.

Reduce salt intake. A low-sodium diet helps lower blood pressure, which in turn reduces the strain on the heart. This won't fix a malfunctioning heart valve, but it may prevent the condition from worsening. Even if surgery is not necessary, doctors typically recommend a low-sodium diet.

• Depending on the severity of high blood pressure, your doctor may suggest reducing salt intake to 2,300 mg or even 1,500 mg per day. Some people consume up to 3,500 mg daily.
• You can lower your salt intake by limiting processed salty foods or canned foods with added salt. Avoid adding extra salt to food, meat during cooking, or rice and pasta cooking water.

Reduce the risk of heart attacks with medication. Your doctor will prescribe medications based on your specific condition and medical history. If you're at risk of blood clots or high blood pressure, medications will be prescribed to treat these conditions. These drugs won't cure heart valve regurgitation but may prevent worsening issues such as high blood pressure. Some commonly prescribed medications include:

• Antihypertensive medications. These are commonly prescribed for mild mitral valve regurgitation.
• Anticoagulants such as aspirin, warfarin (Coumadin, Jantoven), and clopidogrel (Plavix). Blood clotting can lead to strokes or heart attacks, and these medications reduce the risk of clotting.
• Diuretics. These help prevent water retention in the body. If your feet, ankles, or legs are swollen due to poor circulation, your doctor may prescribe diuretics. These also lower blood pressure and reduce swelling caused by tricuspid valve regurgitation.
• Statins. These lower cholesterol levels, as high cholesterol can contribute to high blood pressure and worsen heart valve problems.
• Beta-blockers. These reduce the heart rate, lower blood pressure, and reduce strain on the heart.

Treatment for heart valve regurgitation. The standard treatment for a malfunctioning heart valve is surgery. If you require heart valve surgery, consult a cardiac surgeon who specializes in heart valve regurgitation. This will improve your chances of a successful surgery. The heart valve may be treated through:

• Valve repair. If the surrounding tissue of the valve is abnormal, the doctor may reinforce it with a ring around the valve.
• Direct surgery on the valve or its supporting structures. If the valve is damaged by infection or trauma, the surgeon may adjust it to prevent further leakage.
• Aortic valve replacement with a catheter (TAVR). This modern, minimally invasive procedure is for those who cannot undergo open-heart surgery. Instead of removing the leaking valve, the doctor replaces it with a new one through a catheter. The new valve is expanded and takes over the function of the old one.

Replace the heart valve if it cannot be repaired. Aortic regurgitation or mitral valve regurgitation are common causes for heart valve replacement. The initial approach is to utilize the patient's own tissue, but if that's not suitable, doctors may recommend using tissue from a donor, animal, or a metal valve. Metal valves can last longer, but they increase the risk of blood clots. If you receive a metal valve, you will need to take blood-thinning medication for the rest of your life. The new valve can be implanted using various techniques:

• Aortic valve replacement via catheter. This method is used to replace the aortic valve and is less invasive compared to traditional open-heart surgery. A catheter is inserted through the leg artery or a chest incision to position the new valve.
• Open-heart surgery. Heart valve surgery can extend heart tissue survival and improve quality of life. Most surgeries are successful, and complications are effectively managed (with a 5% mortality rate). Potential complications include bleeding, heart attack, infection, arrhythmias, or stroke. If heart surgery is necessary, it is crucial to consult with an experienced cardiac surgeon, often referred by your cardiologist.